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<p>Background: Small bowel obstruction (SBO) accounts for up to 20% of acute abdomen cases. Approximately 10% progress to strangulated SBO, which carries high morbidity and mortality. Differentiating simple from strangulated SBO remains challenging, especially in resource-limited settings. Biochemical markers such as C-reactive protein (CRP), fibrinogen, D-dimer, and total leukocyte count (TLC) may serve as adjunct diagnostic tools, though their accuracy in the Indian population is underexplored. This study aims to assess the diagnostic utility of CRP, fibrinogen, D-dimer, and TLC in differentiating simple from strangulated SBO and determine optimal cut-off values for early detection of ischemia. Methods: A prospective observational study was conducted at AIIMS Patna from July 2023 to July 2024 on 72 adults with SBO. Based on intraoperative findings, patients were categorized as simple or strangulated SBO. Preoperative levels of CRP, fibrinogen, D-dimer, and TLC were analyzed using Chi-square, Mann–Whitney U, logistic regression, and ROC analyses. Results: CRP (168.5 ± 158 mg/L vs. 55.8 ± 119 mg/L, p = 0.001), fibrinogen (510 ± 180 mg/dL vs. 394 ± 119 mg/dL, p = 0.006), and D-dimer (3.33 ± 3.6 µg/mL vs. 2.17 ± 1.4 µg/mL, p = 0.004) were significantly elevated in strangulated SBO, while TLC showed no difference (p = 0.213). ROC analysis showed CRP (AUC = 0.755) as the best predictor, followed by D-dimer (0.697). Conclusion: Elevated CRP, fibrinogen, and D-dimer reliably predict strangulated SBO. Combining these biomarkers with clinical and imaging findings can improve early diagnosis and outcomes, especially in resource-limited settings.</p>

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A Prospective Observational Study to Assess the Role of CRP, Fibrinogen, D-Dimer, TLC in Differentiating Simple Versus Strangulated Small Bowel Obstruction in a Tertiary Health Care Centre in East India

  • 期刊论文

  • 发表日期：

    2026年4月30日

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  • Surya Vikram,
  • Shashikant Kumar,
  • Deepak Kumar,
  • Sanjit Prasad

摘要

Background: Small bowel obstruction (SBO) accounts for up to 20% of acute abdomen cases. Approximately 10% progress to strangulated SBO, which carries high morbidity and mortality. Differentiating simple from strangulated SBO remains challenging, especially in resource-limited settings. Biochemical markers such as C-reactive protein (CRP), fibrinogen, D-dimer, and total leukocyte count (TLC) may serve as adjunct diagnostic tools, though their accuracy in the Indian population is underexplored. This study aims to assess the diagnostic utility of CRP, fibrinogen, D-dimer, and TLC in differentiating simple from strangulated SBO and determine optimal cut-off values for early detection of ischemia. Methods: A prospective observational study was conducted at AIIMS Patna from July 2023 to July 2024 on 72 adults with SBO. Based on intraoperative findings, patients were categorized as simple or strangulated SBO. Preoperative levels of CRP, fibrinogen, D-dimer, and TLC were analyzed using Chi-square, Mann–Whitney U, logistic regression, and ROC analyses. Results: CRP (168.5 ± 158 mg/L vs. 55.8 ± 119 mg/L, p = 0.001), fibrinogen (510 ± 180 mg/dL vs. 394 ± 119 mg/dL, p = 0.006), and D-dimer (3.33 ± 3.6 µg/mL vs. 2.17 ± 1.4 µg/mL, p = 0.004) were significantly elevated in strangulated SBO, while TLC showed no difference (p = 0.213). ROC analysis showed CRP (AUC = 0.755) as the best predictor, followed by D-dimer (0.697). Conclusion: Elevated CRP, fibrinogen, and D-dimer reliably predict strangulated SBO. Combining these biomarkers with clinical and imaging findings can improve early diagnosis and outcomes, especially in resource-limited settings.